Contraceptives And Their Effects
It is reported that 75% of the world population, live in developing countries characterized by high fertility rates, high maternal and infant mortality and low life expectancy including Nigeria. Although reports showed that worldwide the fertility rates have fallen due to wide-contraception. Studies on contraceptives in Nigeria as in other parts of the developing world have long focused on women as the subject of interest. Therefore, this study seeks to assess the knowledge and use of contraceptives and their effects among male and females in Enugu Local Government Area of Enugu State, Nigeria. The specific objectives are to: assess the kinds of modern contraceptives available in the study area, examine the sources of information on modern contraceptives among male and female in the study area, assess the level of knowledge of modern contraceptives among male and female in the study area, assess the level of use of modern contraceptives among male and female in the study area, examine the effects of contraceptives use in the study area.
The study used quantitative data. The quantitative data were obtained from 384 copies of structured questionnaires where in systematic sampling techniques were employed to facilitate a reasonable representation of men and women from the area under study. The findings revealed that, the level of knowledge of modern contraceptives is almost universal (89.8%) among male and females. This knowledge of modern contraceptives is slightly higher among women ( 45.6%) than men (44.3%). The level of use of modern contraceptives is low (12.2%) and men (7.0%) are the major users than women (5.2%). The major sources of knowledge of contraceptives are family (26.8%) and electronic media (39.9%) while spousal approval (56.5%) is the major determinant factor of contraceptive use. Therefore, there is need for a programme that will focus or encourage male on the practice of contraceptives. Also there is need for a persistent drive against those social customs, beliefs, and traditions which belittle the importance of family planning in the society.
Table Of Content
- Table of Content
- 1.1 Background To The Study
- 1.2 Statement Of The Research Problem
- 1.3 Aim And Objectives
- 1.4 Scope Of The Study
- 1.5 Justification Of The Study
2.0 Literature Review
- 2.1 Conceptual Review
- 2.2 Knowledge And Use Of Contraceptives
- 2.3 Theoretical Framework
3.0 Research Methodology
- 3.1 Research Design
- 3.2 Sources Of Data
- 3.3 Method Of Data Analysis
4.0 Results And Discussion
- 4.1 Results
- 4.2 Discussion
5.0 Conclusion And Recommendation
- 5.1 Conclusion
- 5.2 Recommendation
1.1 Background To The Study
A rapid population growth is a burden on the resources of many developing countries. Unregulated fertility, which contributes to such situations, compromises the economic development and political stability of these countries especially the developing countries (Yahya, 2007). The rate of growth of the population continues to act as a serious impediment to the country‟s march towards economic modernization, sustainable development and poverty eradication. Many international institutions and organizations such as the World Health Organization (WHO), World Bank (WB), United Nations Population Fund (UNPF) and United Nations Children‟s Fund (UNICEF) have strongly advocated contraceptives as a means to space children and limit family size. Contraception has also been a key component of the WHO-UNICEF Child Survival Strategy which goes under the acronym – GOBIFFF (growth monitoring, oral rehydrating salts, breastfeeding, immunization, female education, supplementary feeding and fertility control (Yayha, 2007).
Contraception is a process or technique for preventing pregnancy by means of a medication device or method that blocks or alters one or more processes of reproduction in such a way that sexual union can occur without impregnation (Mosby‟s Medical, Nursing and Allied Health Dictionary 2001). Ehiozuwa ( 2011) defined contraceptive as the prevention of unplanned or unwanted conception or unwanted pregnancy. Wada (2012) sees birth-control or contraceptive as “a fertility regulation process mutually agreed and embarked upon by a man and his partner for the purpose of building a healthy and happy home. It is estimated that in developing countries as many as 1.8 million child deaths could be averted if all pregnancies were spaced by at least three years (Rutstein 2008). In the past few decades investments in family planning programs have raised the level of contraceptive use from 19% to 62% in the developing world and contributed to an estimated 75% decline in fertility (Greanga et al. 2011).
However, despite the increase in supply of and demand for family planning services, gross inequities exist both between and within countries in the use of contraceptives, posing challenges to health policy and programming. Use of modern contraceptives in developing countries remains comparatively low, with West Africa having the lowest rates. In many countries the demand for contraceptives is still not being fulfilled. Worldwide, in 2010 12% of women currently married or in union who do not want any more children or want to postpone their next pregnancies for at least two years are not using any form of contraception that is; they have an unmet need for family planning (Alkema et al. 2013).
In developing countries an estimated 222 million women have an unmet need for modern contraception (Singh and Darroch 2012). The proportion of married women with unmet need for modern contraception is 18% in the developing world as a whole, but is much higher than average (30–37%) in Western Africa, Middle Africa, Eastern Africa and Western Asia, and is somewhat higher than average (22–24%) in South Asia and the Caribbean (Singh and Darroch 2012). Nigeria being the seventh most populous nation in the world has a current estimated population of 183 million, which is projected to reach 285 million by 2050 (United Nations 2013). There are an estimated 35 million women of reproductive age in the country, with an annual number of births of approximately 7 million and annual population growth of 3.2% per annum. The country‟s rapid population growth is attributable to a high total fertility rate (TFR) of 5.5 children per woman (National Population Commission and ICF International and 2014). Thus raising the question if the gospels of the consequences of population explosion are made known to Nigeria and the authorities concern. Family planning is the ability of individuals and couples to attain their desired number and spacing of their children through contraceptive use is one of the most cost-effective public health interventions and is pivotal to reducing the country‟s fertility (Graff, 2014). The fertility level of a country is generally regarded as high when its level is above five children per woman (United Nations, 2009). Nigeria, a country with average fertility rate of 5.7 children per woman can therefore be regarded as having high fertility (Nigeria Demographic Health Survey (NDHS), 2008). Fertility rates have fallen largely worldwide due to the wide contraception but, the fact seem to a utopian in Nigeria. In Nigeria today, the birth rate is higher than the world averages (Nwachukwu and Obasi, 2008).
Nigeria according to Khurfeld (2006) is already facing a population explosion with the resultant effect that food production cannot match the growing population. These growths are as a result of improved control over deaths that have not been matched by controlled births. By implication, the high fertility rate and hence high population growth rate are among the major economic and social problems facing Nigeria. This assertion was based on the fact that high population growth rate is associated with increased level of poverty (Dabral and Malik, 2004); Adanu et al.,2009., Avidime et al.,2010;Adiri et al., 2011) which is observed in the country. In another line of thought, high population rate may also imply excessive burden on the country‟s women. In support of this fact, high fertility rates have been associated with poor child and maternal health, as well as increase risk of maternal mortality (UNFPA, 2008; Chipeta et al 2010; Woldemicael and Beaujot, 2011; Mathe et al). Fertility decline is a means of achieving a demographic dividend, with the consequent potential of reducing poverty, boosting economic growth and contributing to the overall well-being of families and societies (Cleland et al. 2006; Graff and Bremner 2012; Gribble and Bremner 2014). It has been estimated that in Nigeria a reduction in fertility by one child per woman would lead to a 13% increase in GDP per capita within 20 years (Ashraf, Weil, and Wilde 2013). While family planning impacts all the MDG goals, it is most directly associated with MDG 5, improving maternal health (UNFPA and PATH 2008; Ezeh, Bongaarts, and Mberu 2012). Contraceptive use reduces the pregnancy rate, the number of unintended pregnancies and associated induced abortions and the proportion of high-risk pregnancies, therefore causing a reduction in maternal mortality and an improvement in maternal and child health.
Studies have estimated that 30% to 40% of maternal deaths (Gerressu, and Cleland 2004 Singh et al. 2009; Ndugwa, and Zulu 2011; Ahmed et al. 2012; Cleland; Collumbien) and 90% of induced abortion related maternal deaths (Cleland et al. 2006) could be averted if all women who desired to use contraceptives had access to them. In addition, contraception makes significant contributions to reducing levels of infant, neonatal and under-five mortality (Tsui and Creanga 2009). Nigeria is yet to derive significant benefits of family planning, as her use of contraceptives has remained persistently low, prevalence of modern contraceptive use stagnating at 10% among currently married women (National Population Commission and ICF International and 2014), much lower than the African average. The resultant high fertility is a significant contributor to high maternal mortality in Nigeria. Even though Nigeria has only 2% of the global population, it contributes a disproportionate 14% to the global burden of 289,000 annual maternal deaths (World Health Organization 2014). Contraceptive use has increased in many parts of the world even in perpetually highly populated regions like the Latin America and Asia, but the prevalence continues to stagnate in sub-Saharan Africa. Modern contraceptive prevalence in Africa increased from 23% to 24%, Latin America- 64% to 67% while Asia stagnates at 62% (WHO, 2012). Statistics have shown that knowledge of modern contraceptive is as high as 70% in Nigeria but this does not translate into uptake (Adebayo, 2012). Over a period of time, the very little improvement in contraceptive use rose from 3% in 1990 to 10% in 2008 (NPC and ICF Macro, 2009). Also, between 1990 and 2008, contraceptive prevalence rate for all methods increased from 6% to about 15%.
However, use of modern contraceptive methods increased from 4% to 10% between the same periods (FOS, 1992; NPC, 2000; FMOH; 2004, 2006; NPC and ICF Macro, 2009). The current prevalence rate of contraceptive use in Nigeria is approximately 11%-13% (Emmanuel, Andrea, John and James, 2010). According to National Demographic Health Survey (NDHS) 2008, only 10% of married women of reproductive age use contraceptives in Nigeria (UNFPA, 2010). This is lower than the current Sub‐Saharan Africa average of 17%. There are different types of contraceptives which can be broadly categorized as modern (effective) and non-modern (ineffective) methods. Modern methods of contraception include sterilization for male and female, pills, Intra-Uterine Devices (IUDs), male and female condoms. Others are injectables, implants (including Norplant), and vaginal barrier methods. Non-modern techniques of contraception include periodic abstinence, withdrawal method, lactation amenorrhea method (LAM) and folkloric methods. This study focused on the modern contraceptives due to its efficiency and effectiveness.
1.2 Statement Of The Research Problem
The population of Nigeria was reported be 151.87 in 2009 and in 2015; Nigeria‟s population is expected to be 178.72 million persons and above (IMF, 2010). If this growth rate is not checked, the population will double in about 24 years and this will have enormous implications on the economy and the overall development of the country. Today, family planning has been advocated as a control mechanism to regulate and control this rapid population growth. Regrettably, available researches on family planning programmes in Nigeria have traditionally focused on women over the years in order to raise contraceptive prevalence and reduce the level of fertility. Population growth or increase comes about because of the interplay of the three main demographic variables namely fertility, mortality and migration Henrietta, 2006.
This growth can be high, low, constant or stable and all these have implications for a country‟s socio- economic development and hence the standard of living of the people. When human reproduction is left unchecked, it results into high birth rates, bringing about large family size with the negative effects on the health of the respective mothers and children. Consequently this leads to negative impact on the family, the community and the nation at large as a result of economic overload in covering the additional demand. Indeed, uncontrolled births can destroy a nation‟s development aspirations and prevent its people from enjoying an improved standard of living. Nigeria generally has high maternal mortality rates and low contraceptive uptake rates (National Population Commission 2008).
The 2008 Demographic and Health Survey (NDHS) showed that use of regular contraception was 15% in 2008, use of modern contraception was 10% but married women still had a 20% unmet need for family planning (National Population Commission, 2008). The 2013 Demographic and Health Survey (NDHS) also show similar trends in contraceptive use (National Population Commission, 2013). Nigeria like many other African countries is faced with the problem of high population growth rate. A decline in population can result when there is a substantial fall in both mortality and fertility rates. Demographers, health professionals and family planning experts are of the view that one major way by which the country can reduce its fertility is through the use of contraception. It is however disturbing and unfortunate that contraceptive use in Nigeria as in many other African countries is low.
There is therefore, the need for a comparative study on the knowledge and use of modern contraceptives among male and female since most of the previous studies focused on single sex analysis also, previous studies did not single out those modern contraceptives methods since the traditional methods have low efficiency and effectiveness. So this study seeks to address the identified research gap in the field of medical geography, by comparing the knowledge and use of modern contraceptives among male and female in Enugu Local Government Area of Enugu State where, no such study has been done in the past. The study seeks to address the following questions:
1.3 Aim And Objectives
The aim of this study is to examine the knowledge of contraceptives and its effects among individuals in Enugu Local Government Area, Enugu State. This was achieved through the following specific objectives to:
- Assess the kinds of modern contraceptives available in the study area.
- Examine the sources of information on modern contraceptives among male and female in the study area.
- Assess the level of knowledge of modern contraceptives among male and female in the study area.
- Assess the level of use of modern contraceptives among male and female in the study area.
- Examine the effects of contraceptives use in the study area.
1.4 Scope Of The Study
The study is on the knowledge of contraceptives and its effects in Enugu Local Government Area of Enugu State. The study is limited to six (6) council wards out of twelve (12) wards. The study examines the level of knowledge and use of modern contraceptives among men and women of reproductive aged and the socio economic characteristics of the respondents. This study focused only on men and women of reproductive age (15-49 years).
1.5 Justification Of The Study
Most of the studies on contraceptive use are centered on women and there is evidence of ambivalence in the fertility intention and subsequent contraceptive behavior of women Cho, 1978.Monnier, 1989; Cho and Withers et al (2011). A reason for the mismatch in women‟s fertility intention and contraceptive behaviour of women may be due to the influence of the fertility intention of their male partners. Studies have also shown that males are main decision makers on fertility issues and as such have great impact on the fertility intention and contraceptive use of their female partners (Isiugo- Abanihe 1994, Ezeh 1996, Dodoo 1998, Agadjanian, 2006). Furthermore, some studies have shown that men‟s preferences are better predictors of women‟s contraceptive use than women‟s (Dodoo 1998; Dodoo and van Landewijk 1996; Bankole and Singh 1998). Given that fertility intention of men often dominate in their female partner‟s contraceptive use and fertility intention in households (Dodoo et al, 1997; Govinda,et al 2008 and Ibisomi and Odimegwu, 2011.This work will contribute to the existing body of knowledge on reproductive health issues in Nigeria because if the fertility intention of males has an effect or corresponds to their modern contraceptive use, the implication is that since the males are dominant forces in decision making, programmes will be needed to educate men to embrace small family sizes.
5.0 Conclusion And Recommendation
The study is on the knowledge and use of contraceptives and their effects among male and female of child bearing ages in Enugu state. The level of knowledge of modern contraceptive is high with relative low practice. The chi-square tests show the following results: x2 value= 3.082, df= 1,P=0.56 respectively have a significant difference between male and female respondent in the knowledge of modern contraceptives and also x2 value of 1.451, df=1 and p=.276 respectively signifies a significant between male and female respondent in the in use of modern contraceptives. Contraceptive service utilization decision is a function of wide range of factors which include spousal disapproval and lack of spousal communication.
The role of men in promoting contraceptive utilization is generally low. Men are the major decision makers in the use of contraceptives. Involving men and obtaining their support and commitment to family planning is of crucial importance in Nigeria, given their elevated position in the African society. They hold positions of leadership and influence from the family unit through the national level. Male role in contraceptives methods means more than the number of men who encourage and support their partners to use contraceptive methods. The involvement of men in family planning would therefore not only ease the responsibility borne by women in terms of decision making in family planning matters, but would also increase the understanding and practice of family planning in general. There is need for a persistent drive against those social customs, beliefs, and traditions which belittle the importance of family planning in the society. Male involvement and support can help make contraception and family planning easier for the women and even widen the choice of methods that a couple can use since husband’s opposition to contraceptive use can have serious consequences. Culturally, men find it difficult to seek family planning services from women therefore; male service providers should be employed and trained to attend to the men.
It is therefore recommended that:
- The content of contraceptive awareness programmes should focus more on male to increase their knowledge. This will enable them know the important and benefit of small family size as a tool to good health and socio-economic independence.
- Men should be encouraged to be interested and involved in family planning and contraceptive use as they are confirmed as the major decision makers on contraceptive use.
- There is need for a persistent drive against those social customs, beliefs, and traditions which belittle the importance of family planning in the society.
- Women should be allowed to take decision on contraceptives use instead of men restricting them in taking such decision.
- There is need for further research on the demographic and socio-economic determinants of knowledge and use of modern contraceptives among single male and female in other Nigerian states and the implications for national economy.
Contraceptives And Their Effects
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